<style>
    .layui-iconpicker-body.layui-iconpicker-body-page .hide {
        display: none;
    }
    .select_a {
            color: #009688;
            padding: 2px;
            margin: 2px;
            border: #009688 1px dashed;
        }
</style>
<link rel="stylesheet" href="__STATIC__/plugs/lay-module/autocomplete/autocomplete.css?v={$version}" media="all">
<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
                <div class="layui-form-item">
            <label class="layui-form-label">服务名称</label>
            <div class="layui-input-block">
                <input type="text" id="name" name="name" class="layui-input" lay-reqtext="请输入服务名称" placeholder="请输入服务名称" value="{$row['name']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">用户</label>
            <div class="layui-input-block">
                    <div class="layui-form-select" style="width: 200px">
                        <div class="layui-select-title">
                            <input type="text" data-name="name" class="layui-input aselect" placeholder="请输入用户" data-url="/admin/ajax/ajaxselect" autocomplete="off" data-contentid="uid" data-table="user" data-relationship="id">
                            <input name="uid" type="hidden" value="">
                            <i class="layui-edge"></i>
                        </div>
                        <dl id="uid" class="layui-anim layui-anim-upbit"><dd lay-value="" class="layui-select-tips" style="text-align: center"><i class="layui-icon layui-icon-loading layui-icon layui-anim layui-anim-rotate layui-anim-loop">请选择</i></dd></dl>
                    </div>
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">支付订单号</label>
            <div class="layui-input-block">
                <input type="text" id="order_num" name="order_num" class="layui-input" lay-reqtext="请输入支付订单号" placeholder="请输入支付订单号" value="{$row['order_num']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">退款金额</label>
            <div class="layui-input-block">
                <input type="text" id="money" name="money" class="layui-input" lay-reqtext="请输入退款金额" placeholder="请输入退款金额" value="{$row['money']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">退款原因</label>
            <div class="layui-input-block">
                <input type="text" id="reason" name="reason" class="layui-input" lay-reqtext="请输入退款原因" placeholder="请输入退款原因" value="{$row['reason']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">审核失败原因</label>
            <div class="layui-input-block">
                <input type="text" id="back_reason" name="back_reason" class="layui-input" lay-reqtext="请输入审核失败原因" placeholder="请输入审核失败原因" value="{$row['back_reason']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">联系人电话号码</label>
            <div class="layui-input-block">
                <input type="text" id="phone" name="phone" class="layui-input" lay-reqtext="请输入联系人电话号码" placeholder="请输入联系人电话号码" value="{$row['phone']|default=''}">
                <tip></tip>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">状态</label>
            <div class="layui-input-block">
                    {foreach $alldata['field']['status']['option'] as $key=>$vo}
                    <input name="status" value="{$key}" type="radio" title="{$vo}"  {if $key==$alldata['field']['status']['default']}checked=""{/if}>
                    {/foreach}
                <tip></tip>
            </div>
        </div>

        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>
<script>
    var parameter = '{$parameter|raw|default=""}';
</script>